title: Laparoscopic pyeloplasty: the retroperitoneal approach is suitable for establishing a de novo practice.
abstract: BACKGROUND
  Laparoscopic dismembered pyeloplasty has become the "gold-standard" procedure for pelviureteric junction (PUJ) obstruction but consists of a steep learning curve especially via the retroperitoneal route.
  
  
  OBJECTIVE
  To examine the feasibility and safety of introducing this technique via the retroperitoneal approach to a laparoscopic naïve center.
  
  
  METHODS
  A retrospective data analysis of a single surgeon's (NEO) series from a large UK teaching hospital.
  
  
  METHODS
  The notes and imaging of all patients who underwent pyeloplasty for PUJ obstruction by NEO during a five-year period were reviewed.
  
  
  METHODS
  Parametric and nonparametric data are presented analyzed with Excel XP (Microsoft, Redmond, WA, USA).
  
  
  RESULTS
  Our series consists of 67 patients. Three ports were used in 47/57 (82%), and the antegrade technique for stent insertion was utilized in 41/67 (61%). Median time to drink, eat, and mobilize was one day (range one to two), and to discharge three days (range three to four). Two patients required conversion to an open procedure, and two developed intraoperative complications. Postoperative complications at 30 (three major, seven minor) and 90 days (three major, three minor) are presented. With median follow-up of 15 months 61/65 (94%) patients were unobstructed, and 57/63 (90%) of patients were pain-free. Two patients re-obstructed requiring further surgery.
  
  
  CONCLUSIONS
  Analysis of our series of patients illustrates that adopting a policy of retroperitoneal laparoscopic pyeloplasty for primary PUJ obstruction is feasible without compromising patient safety or functional results. There is no need to breach the peritoneum to facilitate the learning curve.
authors.affiliation: Department of Urological Surgery, Royal Hallamshire Hospital, Glossop Road Sheffield, United Kingdom.
authors.forename: R J
authors.initials: RJ
authors.lastname: Bryant
authors.forename: E
authors.initials: E
authors.lastname: Craig
authors.forename: N
authors.initials: N
authors.lastname: Oakley
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D010537:Peritoneum / Q000601:surgery; D012187:Retroperitoneal Space / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000175:diagnosis / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*